Measuring financial protection against catastrophic health expenditures: methodological challenges for global monitoring
Measuring financial protection against catastrophic health expenditures: methodological challenges for global monitoring
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DOI：
10.1186/s12939-018-0749-5
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发表时间：
2018-05-31
影响因子：
4.8
通讯作者：
Hanson, Kara
中科院分区：
文献类型：
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作者：
Hsu, Justine;Flores, Gabriela;Hanson, Kara
背景：监测针对灾难性卫生支出的财务保护对于了解一个国家的卫生融资安排如何保护其人口免受与获得卫生服务相关的高昂费用的影响非常重要。虽然灾难性卫生支出通常被定义为家庭卫生支出超过家庭资源的给定阈值，但没有黄金标准，没有几种方法适用于定义阈值和家庭资源。这些构建指标的不同方法可能会对一个国家在金融保护方面取得的进展给出不同的描述。为了使监测能够有效地提供策略洞察力，理解度量对这些选择的敏感性是至关重要的。方法：本文通过分析来自47个国家的家庭支出数据，考察了不同的两种方法选择的影响。我们通过测试限制性优势来评估跨国比较对一系列阈值的敏感性。通过对国家排名进行相关性检验，我们进一步评估了比较对定义家庭资源（即总支出、非食品支出和非生活支出）的不同方法的敏感性。结果：我们发现，在5-85%的阈值范围内，十分之一到四分之一的比较中，国家排名对阈值的选择是稳健的，如果阈值限制在5-40%，这一比例将增加到一半，按照文献中常用的方法。此外，使用不同方法定义家庭资源的国家排名的相关性从中等到高；因此，从衡量角度来看，这一选择的差异要小于从伦理角度来看的差异，因为对可用家庭资源的不同定义反映了对公平的不同关注。结论：应谨慎解释基于单一阈值的全球监测比较，因为这些比较可能无法提供有关国家相对进展的可靠见解。因此，我们建议使用本文所示的灾难性发生率曲线，在一系列阈值范围内衡量针对灾难性卫生支出的财务保护。我们进一步建议评估与一国卫生筹资系统安排相关的财务保护，以便更好地了解保护的程度，并更好地为未来的政策变化提供信息。
Background: Monitoring financial protection against catastrophic health expenditures is important to understand how health financing arrangements in a country protect its population against high costs associated with accessing health services. While catastrophic health expenditures are generally defined to be when household expenditures for health exceed a given threshold of household resources, there is no gold standard with several methods applied to define the threshold and household resources. These different approaches to constructing the indicator might give different pictures of a country's progress towards financial protection. In order for monitoring to effectively provide policy insight, it is critical to understand the sensitivity of measurement to these choices.Methods: This paper examines the impact of varying two methodological choices by analysing household expenditure data from a sample of 47 countries. We assess sensitivity of cross-country comparisons to a range of thresholds by testing for restricted dominance. We further assess sensitivity of comparisons to different methods for defining household resources (i.e. total expenditure, non-food expenditure and non-subsistence expenditure) by conducting correlation tests of country rankings.Results: We found country rankings are robust to the choice of threshold in a tenth to a quarter of comparisons within the 5-85% threshold range and this increases to half of comparisons if the threshold is restricted to 5-40%, following those commonly used in the literature. Furthermore, correlations of country rankings using different methods to define household resources were moderate to high; thus, this choice makes less difference from a measurement perspective than from an ethical perspective as different definitions of available household resources reflect varying concerns for equity.Conclusions: Interpreting comparisons from global monitoring based on a single threshold should be done with caution as these may not provide reliable insight into relative country progress. We therefore recommend financial protection against catastrophic health expenditures be measured across a range of thresholds using a catastrophic incidence curve as shown in this paper. We further recommend evaluating financial protection in relation to a country's health financing system arrangements in order to better understand the extent of protection and better inform future policy changes.